Vaccines – State of Healthhttps://ww2.kqed.org/stateofhealth
KQED Public Media for Northern CAMon, 19 Mar 2018 21:55:48 +0000en-UShourly1https://wordpress.org/?v=4.2.290498487How Has Your School Performed in Vaccines?https://ww2.kqed.org/stateofhealth/2017/04/28/how-has-your-school-performed-in-vaccines/
https://ww2.kqed.org/stateofhealth/2017/04/28/how-has-your-school-performed-in-vaccines/#respondFri, 28 Apr 2017 22:16:56 +0000https://ww2.kqed.org/stateofhealth/?p=323714Partly proud, partly mortified, Principal José Macias of the Sixty-First Street Elementary School in Los Angeles said that yes, it was true – his school had reported the biggest increase in the rate of fully vaccinated kindergarten students in the state. The number of kindergartners who met all vaccination requirements this year jumped by 82 percentage points at the school, according to data released this week.

“I’m glad,” Macias said, “but it also tells me we were low.”

Parents at Sixty-First Street Elementary support vaccinations for their children, Macias said, but follow-up is sketchy. That’s how the school ended up in 2015-16 with just 12 percent of its kindergartners up-to-date for all vaccinations. The remaining kindergartners – 88 percent of them – were admitted “conditionally” in 2015-16, meaning they had some but not all of the 10 immunizations required by the state, and promised to complete the rest. In 2016-17, the up-to-date vaccination rate for kindergartners at Sixty-First Street Elementary climbed to nearly 95 percent.

While Macias’ school reported the most dramatic upturn, new data from the California Department of Public Health show for the first time how individual schools contributed to a statewide increase in kindergarten vaccination rates to 95.6 percent.

Search this new vaccination database, created by EdSource, a nonprofit news site that focuses on education policy in the state, to see vaccination rates at individual schools.

The new vaccination law, Senate Bill 277, took effect at the start of this school year, eliminating the ability of a parent to obtain a “personal belief exemption” to opt out of vaccinating their children attending public and private schools. But the removal of the personal belief exemption doesn’t account for the overall rise in vaccination rates, according to a summary report from the California Department of Public Health. Instead, schools and parents started to take immunization far more seriously, health officials say.

International publicity about the Disneyland measles outbreak of 2014-15 brought the risk of contracting measles, which had been declared eradicated in the United States in 2000, back as a public health threat. As Senate Bill 277, authored by Sen. Richard Pan, D-Sacramento, wound its way through the Capitol, news reports highlighted testimony from parents who vowed never to vaccinate their children and testimony from parents who had seen the ravages of polio. A 6-year-old Marin County boy with leukemia, Rhett Krawitt, became the public face of the debate.

And state finance auditors announced they would be looking more closely at schools with high rates of kindergartners who were not fully immunized – who were “conditionally” enrolled – to evaluate whether these students were properly enrolled and legitimately eligible for state per-pupil funding, according to the California Department of Public Health summary report. Students who are not fully vaccinated run the risk of not being allowed to attend school.

When the law passed in 2015, staff at many schools launched a full court press to get every eligible incoming kindergartner vaccinated. Collecting immunization paperwork from parents rose to the top of the to-do list. Kimberly Wright, principal of Los Angeles’ Cienega Elementary School, said she made immunizations a permanent agenda item for her meetings with office staff. At the front counter, conversations with parents about vaccinations shifted in tone from a low-key reminder – “well, when you can do it,” Wright said, to “this is really important.” Staff made reminder calls to parents, and Wright kept a list of those with incomplete immunizations on her desk. Increases in vaccination rates at Cienega Elementary rose from 15 percent in 2015-16 to nearly 88 percent up-to-date in 2016-17.

“The vocabulary of the personal belief exemption seemed to imply it was a personal choice with only personal implications, when actually the effect on a community could be profound,” said Matt Willis, public health officer for Marin County.

Matt Willis, public health officer for Marin County, which had some of the highest rates of personal belief exemptions in the state, said that the debate about vaccinations shifted in Marin in part because of Rhett and his story. Chemotherapy had compromised Rhett’s immune system, making him unable to be vaccinated against certain diseases, and leaving him at risk for catching a disease from unvaccinated classmates. He stood on a wooden chair at a March 2015 meeting of the Marin County Board of Supervisors and urged supervisors to support Senate Bill 277 “so kids like me don’t get sick at school.”

“One key was reframing vaccinations entirely as a matter of community responsibility,” Willis said. “The vocabulary of the personal belief exemption seemed to imply it was a personal choice with only personal implications, when actually the effect on a community could be profound.”

In addition, Willis surveyed Marin parents in 2013 about their beliefs about vaccinations, and found that most were choosing to vaccinate their children against some but not all of the 10 diseases. “We weren’t necessarily dealing with a community that was frankly against vaccinations,” Willis said. “That offered hope.”

At Reed Elementary School, Rhett’s school, the percentage of kindergarten students who are up-to-date with vaccinations went from 92.5 percent in 2015-16 to 97 percent in 2016-17. “It was the education of the community,” said Nancy Lynch, superintendent of Reed Union School District in Marin County. “People stepped up.”

Vaccination rates remained low, unsurprisingly, at schools that offer independent study programs or oversee home-schooled students. Students in those programs are not required to be vaccinated, nor are students who receive special education services. Aside from those types of schools, Walnut Avenue Elementary School in Chino Valley Unified had one of the lowest rates of immunizations, with 33 percent of kindergarten students up-to-date on vaccinations in 2016-17. Sixty-seven percent were overdue for vaccinations, meaning they were late getting a scheduled vaccination. According to the California Department of Education, children overdue for one or more required immunizations are subject to exclusion from school until they meet the requirements.

Brenda Dunkle, a spokeswoman for Chino Valley Unified, said the district could not comment on vaccination rates because its director of health services is out of the office until early May.

In Orange County, Pamela Kahn, coordinator of health and wellness at the Orange County Department of Education, said that education about immunizations unfolded with every news cycle in 2015 as dozens of children and adults, most of whom were unvaccinated, contracted measles after visiting two Disney theme parks in Anaheim.

“No. 1 was the Disneyland measles outbreak,” she said. “This brought people’s attention to the fact that this does still happen.”

An exodus of students from schools to home schools to avoid vaccinations didn’t occur, Kahn said. “We knew there would be some,” she said, and there were.

Along with the statewide increase in the vaccination rate, the rate of medical exemptions also rose, from 0.2 percent to 0.5 percent. A medical exemption requires a letter from a doctor stating the health reasons why a child cannot be vaccinated against certain diseases; there is no official form.

“From a medical point of view, there are some letters that are kind of suspicious,” Kahn said. “For example, we get the same exemption letter, with the same language, for different kids, from the same doctor. It could be ‘a familial history of reactions to immunization.’ That could be a cousin, a third cousin. One person wrote that this child was exempt until a date that correlates to high school graduation. That’s odd.”

But the schools don’t question the exemption letters, she said. “We were advised that we are not the medical experts,” she said.

“I think people are still looking for avenues not to be vaccinated,” said Dr. Kenneth Cutler, public health officer for Nevada County, which also has had pockets of unvaccinated students. Kindergarten vaccination rates for the county reached 81 percent, up from 69 percent about five years ago, he said.

Some schools in the county reported high levels of medical exemptions and high levels of personal belief exemptions, which were carried over from last year when the students were in transitional kindergarten. The law states that those exemptions remained valid for kindergarten this year.

But Sharyn Turner, school health services coordinator at the office of the Nevada County Superintendent of Schools, said she did see signs of change in what has been a strong anti-vaccination culture at some schools. In those schools, she said, parents who opposed vaccinations shunned some pro-vaccination parents. But Turner’s vaccinated grandson now attends School of the Arts, which has a history of being popular with vaccine opponents, and she said the family has been welcomed. “You are no longer excluded because you vaccinate your child,” she said.

Others remain outliers in the vaccination landscape.

At the Mountain Oaks School in Calaveras County, where all students are in independent study or home-school programs, supplemented by on-site classes for those who are vaccinated, 39 percent of kindergartners were up-to-date on vaccinations. Fifty-seven percent did not have to be immunized because they are not receiving classroom instruction or they are receiving special education services. An additional 4.5 percent had a medical exemption.

Vaccinated students can attend group classes at school, including pottery and algebra, said Anne Colman, administrator of Mountain Oaks School.

“Despite that, the percentage of parents who don’t care that their kids can’t take classes at school is really high,” Colman said.

Unvaccinated students had to stay home from a recent outdoor adventure school trip, she said. “We’re trying very hard to err on the side of caution,” she said. “I do not want to be the administrator on the 11 o’clock news – ‘Plague outbreak after unvaccinated kids are let in.’”

“Our parents are nothing if they’re not rebels, and they have been for a gazillion years,” she said.

At Sixty-First Street Elementary, planning for next year’s kindergarten immunization checks are well underway. At school drop-off in the morning, Macias sticks his head into parents’ cars and tells them he wants their younger children as kindergartners next year, but they need to be vaccinated. School staff photocopy flyers with the locations of health care clinics, translate forms into Spanish, and offer, time and again, to help parents get the job done.

“The only thing we haven’t done is bring the doctor here,” Macias said.

]]>https://ww2.kqed.org/stateofhealth/2017/04/28/how-has-your-school-performed-in-vaccines/feed/0323714Vaccination Rates for California Kindergarteners Are Higher Than Ever After New Lawhttps://ww2.kqed.org/stateofhealth/2017/04/17/vaccination-rates-for-california-kindergarteners-are-higher-than-ever-after-new-law/
https://ww2.kqed.org/stateofhealth/2017/04/17/vaccination-rates-for-california-kindergarteners-are-higher-than-ever-after-new-law/#respondMon, 17 Apr 2017 16:44:32 +0000https://ww2.kqed.org/stateofhealth/?p=319083Vaccination rates hit an all-time high for California kindergartners, the California Department of Public Health said Wednesday as it announced its first findings since a new law ended the era of the “personal belief exemption” that allowed thousands of parents to choose not to vaccinate their children who attend public and private schools.

The percentage of kindergartners who received all required vaccines rose to 95.6 percent in 2016-17, up from the 92.8 percent rate in 2015-16. This is the highest reported rate for the current set of immunization requirements, which began in the 2001-02 school year, the state said.

“It’s a great thing for California kids,” said Catherine Flores Martin, director of the California Immunization Coalition. “It’s a big win for schools and communities.”

To be clear, California parents do not have to immunize their children. But under the new law, Senate Bill 277, passed in 2015, children must be immunized against 10 serious communicable diseases if they want to attend public or private schools and child care centers. If unvaccinated, children must be home schooled or enrolled in independent study with no classroom instruction or receiving special education services, the California Department of Public Health said.

Children may be granted a medical exemption to vaccinations with a note from a doctor attesting that the child’s health condition prohibits vaccinations. Rates of medical exemptions rose to 0.5 percent in 2016-17 from 0.2 percent in 2015-16. The California Department of Health also released a new category of information – 0.5 percent of kindergartners were reported as lacking full immunization because they attended private home schools or independent study programs or received special education services.

Tulare County had the highest rate – 98.5 percent – of vaccinated kindergartners followed by San Benito County with 98.1 percent, the state said.

But even with the increase in vaccination rates, nine counties have vaccination rates below 90 percent for kindergartners, the state said. A 90 percent to 95 percent vaccination rate is considered “herd immunity,” the rate necessary to protect a community – particularly those who are too sick or too young to be vaccinated – from an outbreak of many types of contagious diseases. Measles, which is highly contagious, requires a 95 percent vaccination rate to protect the community, health officials say.

While personal belief exemptions are no longer granted, 0.6 percent of kindergartners were not vaccinated because of a personal belief exemption they had obtained a year earlier in transitional kindergarten. The law stated that their exemption would continue to be valid in kindergarten. All told, 1.5 percent of kindergartners lacked required immunizations in 2016-17, a decline from the 2.5 percent rate in 2015-16, because of medical exemptions, previously awarded personal belief exemptions or enrollment in home schooling, independent study or special education, the state said.

At hearings at the state Capitol, hundreds of parents vociferously pleaded with legislators not to repeal the personal belief exemption. But public health advocates prevailed.

In California and elsewhere, nonmedical exemptions have created pockets of unvaccinated children that have facilitated the spread of potentially life-threatening diseases, particularly measles and pertussis, according to a 2016 research review published in the Journal of the American Medical Association in 2016.

The most at-risk groups for the diseases are infants who are too young to be vaccinated and individuals with compromised immune systems.

]]>https://ww2.kqed.org/stateofhealth/2017/04/17/vaccination-rates-for-california-kindergarteners-are-higher-than-ever-after-new-law/feed/0319083California’s New Vaccine Law Expected to Send Disease Rates Plummetinghttps://ww2.kqed.org/stateofhealth/2016/08/09/californias-new-vaccine-law-expected-to-send-disease-rates-plummeting/
https://ww2.kqed.org/stateofhealth/2016/08/09/californias-new-vaccine-law-expected-to-send-disease-rates-plummeting/#commentsTue, 09 Aug 2016 21:16:22 +0000http://ww2.kqed.org/stateofhealth/?p=222927Mississippi hasn’t had a case of measles since 1992. West Virginia last saw measles – a highly contagious virus that kills an estimated 314 people worldwide every day – in 2009. Now, with California’s new vaccination law rolling out shot by shot, the state joins Mississippi and West Virginia to become the third in the nation to adopt stringent vaccination school entrance requirements. And medical experts say disease rates are likely to fall in California as they have in those states.

“It’s a good club to be in,” said Rahul Gupta, state health officer in West Virginia, who was effusive in welcoming California – home to more than eight times the number of children under the age of 18 as Mississippi and West Virginia combined – as a public health leader in school vaccinations, a role that the two Southern states have played for decades. “What we are seeing in West Virginia is a significant decline in vaccine-preventable diseases,” he said. “We expect the same in California.”

“We haven’t had a measles case in a schoolchild in decades,” said Thomas Dobbs, state epidemiologist in Mississippi, which has the highest school vaccination rate in the nation for measles, mumps and rubella with 99.7 percent of students receiving the immunization.

More than a year after a measles outbreak at Disneyland and Disney California Adventure spread to 134 Californians, as well as to residents in six other states and two other countries, the new law removes the personal belief exemptions that allowed parents not to vaccinate their children in public or private schools or child care centers based on an opposition to vaccines. As in Mississippi and West Virginia, California now allows only children who have a medical reason to be excused from the mandate if they wish to attend public or private schools and child care centers. Child by child, the new vaccination requirements, which took effect July 1, are being applied to babies, toddlers and students entering public or private child care, kindergarten and 7th grade.

Passing the law, known by its legislative number as Senate Bill 277, was arduous at times, as vaccination opponents traveled to Sacramento legislative hearings to voice their belief in a retracted 1998 case study that suggested a link between vaccinations and autism – a case study that the British Medical Journal declared to be “an elaborate fraud.” Public health advocates now are having a moment.

“Policies need to be based on science, not unfounded conjecture,” Dobbs said. “I am very impressed with California.”

California has more than 9 million children under the age of 18, compared with 737,000 children in Mississippi and 382,000 children in West Virginia, according to 2015 figures, making the impact of improved vaccination rates all that more significant.

“Nobody – myself included – was very confident that we could accomplish this law,” said Mark Sawyer, a member of the American Academy of Pediatrics Committee on Infectious Diseases and a medical school professor at UC San Diego. “Now people can see that it can be done – the legislators weighed the risks. I think other states will follow.”

“The likelihood is very strong that the end result will be fewer cases of vaccine-preventable diseases in California,” said Arthur Reingold, professor of epidemiology at the UC Berkeley School of Public Health. Several studies have documented that the easier it is for parents to decline to immunize their children, the higher the opt-out rates are and the greater the risk of outbreaks of measles and pertussis, also known as whooping cough.

In the absence of a federal law requiring school children to be immunized, state governments set the standards. Every state allows children to be exempt from vaccinations if they have a medical reason, such as a compromised immune system or a severe allergy. But 47 states allow parents to choose not to vaccinate their children because of a personal or religious opposition to vaccination. A parent’s right not to vaccinate a child based on beliefs has been defeated several times in Supreme Court rulings that state there is a greater public good in widespread immunization.

West Virginia instituted its vaccination requirements in 1987, has been strengthening them ever since and has never had a religious or personal belief exemption. Mississippi set its vaccination requirements in 1972, never had a personal belief exemption and ended its religious exemption in 1979, when the state Supreme Court ruled against such exemptions.

But in the ensuing decades, the fraudulent paper on the possible link between vaccinations and autism by Andrew Wakefield, a British doctor who was stripped of his medical license by a government review board, has sowed fear in parents and wreaked havoc on vaccination rates in Europe and, to a lesser extent, in the U.S. Both Gupta and Dobbs noted that it is far easier never to have had exemptions to vaccination requirements, or to have removed them decades ago, than to remove them in 2015 as California did.

West Virginia legislators continue to strengthen vaccination laws and in 2015 extended vaccination requirements to preschoolers. Amid complaints from a few parents that medical exemptions were being granted or denied without consistency, legislators last year created the position of state immunization officer, who is in charge of ruling whether a medical exemption is warranted. Having the state immunization officer has reduced complaints to legislators, Gupta said, “and significantly reduced criticism” of the vaccination requirements.

In California and elsewhere, non-medical exemptions have created pockets of unvaccinated children that have facilitated the spread of potentially life-threatening diseases, particularly measles and pertussis, according to a 2016 research review published in the Journal of the American Medical Association in 2016.

The most at-risk groups for the diseases are infants who are too young to be vaccinated and individuals with compromised immune systems, Sawyer said. On July 15, a previously healthy 5-month-old San Diego infant died of pertussis, according to the San Diego County Health and Human Services Agency. On the same day, a 51-year-old San Diego man said to have underlying health issues died of complications from chicken pox, the health agency said.

]]>https://ww2.kqed.org/stateofhealth/2016/08/09/californias-new-vaccine-law-expected-to-send-disease-rates-plummeting/feed/259222927Fever-Caused Seizures Following Vaccines Are Rare, Study Sayshttps://ww2.kqed.org/stateofhealth/2016/06/07/fever-caused-seizures-after-childhood-vaccines-are-rare-study-says/
Tue, 07 Jun 2016 17:14:24 +0000http://ww2.kqed.org/stateofhealth/?p=195134A seizure caused by a fever in a young child can be terrifying, and some parents worry that the occasional fever that can follow a vaccine may cause one. But febrile seizures after vaccines are rare, a study finds, affecting 3 children out of 10,000. And children almost always recover completely.
‘If you’re really concerned about febrile seizures, the smartest strategy is to protect your child against the infection with the vaccine.’ Dr. Mark Schleiss, University of Minnesota

The study, published Monday in Pediatrics, found that only a few vaccines or vaccine combinations increase the risk of febrile seizures. The pneumococcal vaccine given alone increases the risk, and so does the flu vaccine if given at the same time as either the pneumococcal vaccine or DTaP (diphtheria, tetanus, pertussis) vaccine.

The pneumococcal vaccine, or PCV, protects against pneumococcal disease. The pneumococcus bacteria can cause infections ranging from an ear infection to pneumonia to pneumococcal meningitis, which kills 1 in 15 children under 5 who develop it.

“The basic message is, while there is an increase compared to giving them on separate days, the absolute amount of that risk is so, so very small that for the average person, it won’t really affect their chances of having a febrile seizure,” lead study author Jonathan Duffy tells Shots.

Febrile seizures, he adds, are considered isolated, benign events with no long-term consequences in the vast majority of children. They occur in approximately 2 to 5 percent of children, caused infections or other conditions that can cause a fever, according to Mark Sawyer, a professor of clinical pediatrics at University of California San Diego School of Medicine and Rady Children’s Hospital in San Diego.

“For anybody who’s seen a febrile seizure, it is a scary experience,” Sawyer says. “People are not responding, sometimes they are not breathing very effectively, and there’s uncontrolled twitching of arms and legs, so people assume there must be something major going on in the brain, but fortunately, that’s not the case.”

Febrile seizures occur most typically in children between 1 and 2 years old — the same ages when children receive a number of vaccines. Sometimes other seizures may follow if the child has a disorder such as epilepsy, but no evidence has suggested that a febrile seizure can cause seizure disorders.

“If you’re really concerned about febrile seizures, the smartest strategy is to protect your child against the infection with the vaccine,” Mark Schleiss, director of pediatric infectious diseases at the University of Minnesota, told Shots. About 20 percent of children hospitalized for influenza, for example, experience febrile seizures, he says. “I find this paper reassuring about vaccine safety,” he adds.

Duffy, a medical officer in the Centers for Disease Control and Prevention Immunization Safety Office, says they conducted the study to follow up on reports five years ago that found an increased risk of febrile seizures when the flu and pneumococcal vaccines were given the same day.

This study used the Vaccine Safety Datalink, a massive database that tracks millions of children receiving vaccines in nine health systems across the U.S. The very large population size — approximately 9.8 million for this study — ensures the highest quality data possible in assessing vaccine safety. It’s the largest vaccine safety surveillance program of its kind.

The researchers identified all children between 6 and 23 months old who had a febrile seizure within 20 days of at least one vaccine between 2006 and 2011. They compared the number of seizures occurring the day of or after a vaccine with those occurring 14 to 20 days after the vaccine in the same children. The first 24 hours is the time a febrile seizure caused by inactivated vaccines is biologically possible.

The researchers skipped days 2 to 14 because febrile seizures from live vaccines, such as the measles-mumps-rubella and chickenpox vaccines, are biologically likely then. The risk of a febrile seizure from these vaccines is already known to be 1 in 3,000 doses.

Among 333 febrile seizures that occurred following nearly 2 million vaccinations, half the children had had a previous febrile seizure. Those not caused by a vaccine resulted from respiratory tract infections, urinary tract infections, ear infections and viral infections.

A slightly increased risk of 3 febrile seizures per 10,000 children existed when receiving the PCV vaccine by itself, the inactivated trivalent influenza vaccine with either the PCV or DTaP vaccine, or all three vaccines together. A commentary accompanying the study, co-authored by Sawyer, calculated that this risk translates to approximately 1 child with a vaccine-caused febrile seizure every 5 to 10 years in the practice of an average pediatrician, seeing 1,000 children under 5 each year.

“While we’ve done all this work to quantify this risk, what we’ve found is that even at the highest risk we’ve seen [it] is still very small in absolute terms,” Duffy says. “The pneumococcal vaccine prevents life-threatening conditions such as blood infections and meningitis, so the benefits of getting that vaccine are so much greater than the very small risk of getting a febrile seizure, which does not have the potential to cause long-term damage such as those infections can.”

Though parents of children with a history of febrile seizures might want to discuss separating these vaccines with their child’s doctor, that’s not the wisest plan overall, Sawyer told Shots.

“What we know from many years of experience is that every time you skip a vaccine, a certain percentage of those kids will never get that vaccine or the doctor doesn’t realize they didn’t get that vaccine,” Sawyer says. “Parents are going to naturally assume ‘That’s not me, of course I’ll bring my child back,’ but not everybody does, and then we have susceptible children in our community.” Separating these vaccines also leaves children susceptible to those illnesses for longer, he added.

“It’s kind of like not wearing a seat belt for two weeks,” Sawyer says. “If you end up in a car accident in those two weeks, you’re going to wish you had been wearing your seat belt.”

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

]]>195134Must California’s Special Ed Students Be Vaccinated? State Won’t Sayhttps://ww2.kqed.org/stateofhealth/2016/05/10/must-california-special-ed-students-be-vaccinated-state-wont-say/
https://ww2.kqed.org/stateofhealth/2016/05/10/must-california-special-ed-students-be-vaccinated-state-wont-say/#commentsTue, 10 May 2016 17:04:53 +0000http://ww2.kqed.org/stateofhealth/?p=182945Let the courts decide.

That appears to be the stance of the California Department of Education as state regulators have so far declined to answer pleas from school districts to clarify what California’s new vaccination law means for the 700,000 students who receive special education services.

Tension between state law mandating vaccines for virtually all students and federal law requiring services for special ed students

Known as Senate Bill 277, the state law makes California one of three states to permit exemptions to school vaccinations only for medical reasons.

Gone are exemptions based on religious or personal beliefs. The law says all public and private school students must be vaccinated against 10 communicable diseases unless they have a medical exemption, they are home-schooled or they are enrolled in independent study with no classroom instruction.

With school districts beginning to enforce the law on July 1, legal experts say a conflict is likely to arise between the state mandate and the federal Individuals with Disabilities Education Act, which says students who qualify for special education services, such as intensive reading interventions that are provided in general classrooms, must receive those services. A conflict also has the potential to unite two impassioned groups of parents — those who oppose vaccinations and those who insist on the right of students to receive special education services in mainstream classrooms, attorneys said.

But what if the special education student is unvaccinated? Would that student be allowed to attend school? Or would an unvaccinated special education student have to receive services at home? Lawyers have lined up on both sides of the issue, offering conflicting opinions on how the state law intends school districts to carry out its mandate. It’s an argument that lawyers on both sides say is likely to end up in court.

The California Department of Education has said it will not be providing guidance on interpreting the new law, although it typically does so with new legislation, said Greg Rhoten, chairman of the Special Education Local Plan Area Administrators of California, which represents special education programs in the state. Rhoten said he asked two experts — Fred Balcom, the director of the special education division of the California Department of Education who retired last year, and Chris Drouin, now the interim director of special education — for guidance from the department and was told by both that none would be forthcoming.

He said he was told to follow guidance from the California Department of Public Health. “That wasn’t helpful to us,” Rhoten said, noting that public health department officials are not likely to be well-versed in special education law.

“I assume the state is trying to be careful about assuming risk for interpretation of the law,” which could make the department a party to a lawsuit, Rhoten said. “In the end, it’s the implementers,” he said, referring to the school districts. “They’re the ones who have to make the calls and do their best.”

In lieu of state guidance, districts have hired lawyers or turned to their general counsel for advice on how to proceed. Los Angeles Unified School District, which serves more than 640,000 K-12 students, said that on the advice of legal counsel, the district will not require students in special education to comply with required immunizations if that requirement would prevent them from getting services, including instruction in general education classrooms, to which they are legally entitled.

The California Department of Education referred media inquiries about the vaccination law to the California Department of Public Health, which in turn, referred questioners to its Senate Bill 277 Frequently Asked Questions web page. Last month, the department quietly posted an update that had been long anticipated by districts, but the information fell short of providing helpful guidance, some lawyers said.

In describing students who have individualized education programs through special education, the update explained in words underlined for emphasis that “parents or guardians must continue to provide immunization records for these students to their schools, and schools must continue to maintain and report records of immunizations that have been received for these students.”

But does “continue to provide immunization records” mean that students in special education must be vaccinated? Ronald Wenkart, general counsel for the Orange County Office of Education, says it does. “You wouldn’t have a record if you were not immunized,” said Wenkart, who has become a bit of a Kremlinologist in trying to decipher the text of the law and the public health department updates. His office has advised districts that the intention of the law — to improve immunization rates — calls for all students who receive special education services to be vaccinated, unless they have a medical exemption.

“This is about the same guidance we got to begin with,” said Paul Lavigne, executive director of the Greater Anaheim Special Education Local Plan Area. “The law is vague on it. It says students need to receive IEP services but it also says they need to be vaccinated. More guidance would be great.”

“I would have hoped that if the state were to clarify this, they would provide a little more specific clarification than that,” said Jonathan Read, a partner at the law firm Fagen Friedman & Fulfrost.

At the same time, a March 1 revision to the California Department of Education Audit Guide, which instructs auditors how to monitor district compliance with the law, states that auditors who are checking on immunization compliance should exclude students who have individualized education programs and receive special education services.

Wenkart said the audit guidance would create further confusion. “That will give people the false impression that these kids don’t have to be vaccinated,” he said.

With this much uncertainty, the issue will likely make its way to court, said Rhoten of the statewide special education association. “What happens is that case law gets made,” he said.

Rhoten offered this scenario: A district decides that an unvaccinated special education student must be taught at home. The student’s parents file a complaint, arguing that their child is not receiving a “free and appropriate education” in the least restrictive environment. The matter goes before an administrative judge in a due process hearing. The judge considers the student’s right to special education services as well as the school’s obligation to protect the health and safety of other students and staff. One way or another, a ruling is made.

One of the three students sickened in last week’s meningococcal disease outbreak at Santa Clara University is the son of Penny Nelson, who works with me at KQED News. What’s especially interesting about his case is that he had received a new vaccine against the illness, yet still got sick.

‘We don’t know if it impacts herd immunity. We don’t know how long immunity lasts. Is it a few years? Five years? Ten years?’Dr. Cody Meissner, Tufts Univ. School of Medicine

Backing up a bit, the outbreak was caused by Neisseria meningitidis serogroup B, an especially serious infection. All three students now have been discharged from the hospital in good condition. Two of them, including Nelson’s son, Misha Hindery, were treated for meningitis, an infection of the lining of the brain and spinal cord. A third student had septicemia, a bloodstream infection.

The disease is fatal in 10-15 percent of cases, and many others lose a limb or suffer brain damage.

Nelson knew how serious a disease it could be. A few years ago, a friend’s daughter contracted a serogroup B infection at college and died within days, despite aggressive medical treatment.

When Nelson found out her son was in the hospital, she says she got there as fast as she could. “I was so frightened. I just couldn’t believe it. … I sat there and read about it, and that frightened me even more.”

After Misha was released, Nelson contacted his primary care doctor, who confirmed that Misha had received both doses of Bexsero. The vaccine was approved by the Food and Drug Administration (FDA) a year ago, under an accelerated process, says Dr. Cody Meissner, a pediatrics professor at Tufts University School of Medicine and consultant to the Advisory Committee on Immunization Practice, which recommends vaccine guidelines to the Centers for Disease Control and Prevention (CDC). It is intended for people ages 10 to 25.

The vaccine was developed in a new way, a “terrific accomplishment” technologically, Meissner said. But because of the shortened approval process, much is not known about it. “We don’t know if it impacts herd immunity,” he says, in reference to vaccinating enough of a population to keep a disease that crops up from spreading. “We don’t know how long immunity lasts. Is it a few years? Five years? Ten years?”

Bexsero and a second vaccine, Trumenba, cover most — but not all — strains of bacteria within the serogroup B. It’s possible Misha was infected with a strain that is not included in the vaccine. Meissner said there is no scientific evidence to support the idea that the vaccine makes the course of the disease less severe, if someone does become infected.

And while meningococcal group B infections are rare — just 160 cases in 2012 — they can be devastating, often striking young, healthy people. Nelson’s son rows crew and was a member of an eight-man boat that won a national title last year.

Public health officials are now watching to see how the vaccine performs, says Dr. James Watt with the California Department of Public Health.

“These vaccines have been used in outbreaks,” he said. “They have appeared to have an impact, so that’s good news.” Together with the Santa Clara County Public Health Department, Santa Clara University ran four vaccine clinics, ending Monday. Nearly 5,000 of the university’s 8,000 undergraduate and graduate students received the first dose.

Penny Nelson with her son, Misha. He is recovering from bacterial meningitis. (Courtesy: Penny Nelson)

The California Department of Public Health will provide 5,000 doses next month, when students will need the final shot in the two-dose series.

The vaccine is not part of the routine immunization schedule for adolescents. Instead, it received a “permissive” recommendation, meaning that doctors can administer it if they feel it is in the best interest of the adolescent. Some people at high risk should be immunized, according to the Centers for Disease Control and Prevention, including anyone with a damaged or removed spleen, sickle cell anemia or who has a rare immune system condition known as “complement deficiency.”

California follows CDC guidelines, so does not require the vaccine for school-age children. Watt says California colleges and universities set their own vaccine guidelines.

Meanwhile, cases are dropping. In the late 1990s, there were 1-2 cases per 100,000 people. Now it’s 0.1 per 100,000. “Meningococcal disease is disappearing in the U.S.,” Meissner says. “No one knows why.”

On top of everything else, this vaccine is expensive, more than $300 for the series. Meissner published an analysis in Monday’s JAMA spotlighting the challenges of providing such an expensive vaccine for such a rare disease. As many as 350,000 adolescents would need to be vaccinated to prevent one case of disease, he wrote.

“This vaccine is 25 times higher [in cost] than any other vaccine,” he told me.

“Is this the way we want to be spending scarce funds for public health?”

]]>https://ww2.kqed.org/stateofhealth/2016/02/09/santa-clara-university-student-with-meningitis-was-vaccinated-what-happened/feed/10146097PennyPenny Nelson with her son, Misha. He is recovering from bacterial meningitis.Whooping Cough ‘Booster’ Vaccine Protection Fades Quickly, Kaiser Study Showshttps://ww2.kqed.org/stateofhealth/2016/02/04/whooping-cough-booster-protection-fades-quickly-kaiser-study-shows/
https://ww2.kqed.org/stateofhealth/2016/02/04/whooping-cough-booster-protection-fades-quickly-kaiser-study-shows/#commentsFri, 05 Feb 2016 06:31:30 +0000http://ww2.kqed.org/stateofhealth/?p=145269In the late 1990s, a new version of the whooping cough vaccine was introduced. The big benefit was that it had fewer side effects. But in the years since, evidence has been mounting that this newer vaccine loses its effectiveness — and fast.
‘Routine vaccination of 11- and 12-year-olds does not appear to be preventing outbreaks.’Dr. Nicola Klein, Kaiser Vaccine Study Center

Now, another study sheds light on how well the “booster” dose works. California requires this booster — called Tdap — for all incoming 7th graders.

Researchers at the Kaiser Permanente Vaccine Study Center looked at the protection level of 175,000 adolescents in the Kaiser Northern California system vaccinated with Tdap. And just as with earlier studies, they saw that protection faded.

“What we found was the the Tdap vaccine offers moderate protection in the first year,” said Dr. Nicola Klein, co-director of Kaiser’s vaccine center, “but then that rapidly decreased over the next four years, so by the time we were at four years after vaccination, it was down to nine percent.”

There have been two statewide whooping cough — also called pertussis — epidemics in recent years. The first was in 2010, the second in 2014, which was the first where all adolescents had received only the newer pertussis vaccine, the “acellular pertussis” vaccine: five doses by age 6, plus the booster before 7th grade. The 2014 epidemic was even more severe than the one in 2010.

“Unfortunately,” said Klein, “routine vaccination of 11- and 12-year-olds does not appear to be preventing outbreaks.”

The question becomes what to do about it — especially since the authors predict the situation will only get worse. “Future pertussis epidemics,” they write in the study, will “be larger as the cohort that has only received acellular pertussis vaccines ages.”

At the very end of the study, published in the journal Pediatrics, the authors raise the question of a different strategy, one where the vaccine was “administered to adolescents in anticipation of a local pertussis outbreak, rather than on a routine basis.”

It seems like a good idea, but it’s one that would be a significant departure for the U.S., according to Dr. Arthur Reingold, head of epidemiology at the UC Berkeley School of Public Health.

“The United State doesn’t have a lot of experience in doing mass campaigns in response to or in preparation of an outbreak,” he said.

It might also seem reasonable to give doses more frequently. But Reingold, who also chairs the pertussis group for the nation’s Advisory Committee on Immunization Practices, says first you need a lot of evidence that extra doses are both safe and effective.

“Give a dose at 12 [years], another one at 15 and another one at 18,” Reingold questioned. “It’s expense and it’s complicated, and it’s not clear what the effects would be. There’s not a clear solution at this point.”

A clear solution would be a new vaccine that is, again, safe and effective. Reingold says that’s at least five years off.

In the meantime, no adolescents died or were hospitalized in the 2014 epidemic. Klein referred to pertussis as a “mild to moderate disease.” Yet, the illness is often referred to as “the 100-day cough.”

“It’s not a deadly disease,” Klein said, “but it is an impact on kids’ lives.” And parents, too, who may have to take time off work to care for their sick children.

It becomes a question of priorities in a limited-resources world. “At the public health level, the emphasis is on preventing deaths and hospitalizations,” Reingold said. “How much money do we want to spend … to prevent the 100-day cough?”

“It’s a perfectly legitimate question, and I don’t know the answer.”

]]>https://ww2.kqed.org/stateofhealth/2016/02/04/whooping-cough-booster-protection-fades-quickly-kaiser-study-shows/feed/2145269Why Vaccination Rates Are Up Across Californiahttps://ww2.kqed.org/stateofhealth/2016/01/20/why-vaccination-rates-are-up-across-california/
https://ww2.kqed.org/stateofhealth/2016/01/20/why-vaccination-rates-are-up-across-california/#commentsWed, 20 Jan 2016 21:31:44 +0000http://ww2.kqed.org/stateofhealth/?p=140964Vaccination rates are up in 49 out of 58 counties in California, according to data released Tuesday by state health officials.

The California Department of Public Health annually reports vaccination data for kindergartners at virtually all public and private schools statewide. For the 2015-2016 school year, 92.9 percent of kindergartners were up-to-date on their vaccines, an increase of 2.5 percentage points from last year.

In California, 2015 was the year of heated debate around vaccines. It started last January with the first reports of a measles outbreak tied to Disneyland. Then, in early February, lawmakers introduced a bill to eliminate the “personal belief exemption” (PBE) which allows parents to refuse vaccines on behalf of their children.

The law takes effect in July, but this school year the PBE rate declined slightly — it’s now 2.38 percent, down from 2.54 percent last year. It’s the second straight year of declines.

While no one can say for sure exactly what’s driving the increasing vaccination rates, it seems reasonable that all the focus on vaccinations — and those who choose not to vaccinate — last year had an impact.

But James Watt, chief of the division of communicable diseases with the state’s department of public health, says another big factor is “conditional admissions.” These are children who arrive at school with some vaccines, but are not up to date.

This school year, 4.4 percent — about 24,000 — of the state’s 550,000 kindergartners were admitted conditionally.

The problem, Watt explained to me in an interview, is that the rules around conditional entry are actually quite strict. It’s not simply that a child has some vaccines and will get the rest at a later date. In other words, “conditional entry” is not for children whose parents haven’t gotten them to the doctor’s office or clinic for a shot.

“If those children could get a dose ‘today,’ they’re not supposed to be admitted to school,” Watt says.

To say it in reverse — conditional entry is for children who cannot be vaccinated “today.”

Why couldn’t you be vaccinated “today”? Here’s one example: Children are supposed to receive two doses of the measles, mumps, rubella (MMR) vaccine. But the second dose can only be given starting one month after the first dose. If school starts less than one month after the child has had the first MMR dose, then the child is eligible for “conditional entry” to school, until the month has passed and the second dose can be given.

Department of public health estimates show that more than 90 percent of those 24,000 children with conditional entry do not meet the requirements of the policy and should not have been admitted to school.

Watt says the criteria have been misunderstood and “can be confusing,” so the state’s health department has been working with local health departments to inform them about correct use of conditional entry. In addition, schools financial and compliance audits for the current school year “will scrutinize reimbursements for attendance at schools with higher rates of conditional entrance.”

The department said it turned to approaches used successfully by the Alameda County Public Health Department. The state says Alameda had the biggest decrease — 7.2 percent — of any California county in its conditional entry rate. Statewide, the rate declined 2.5 percent.

Watt acknowledged “there is a tension” between health requirements and school attendance, but even if children need vaccinations, there’s “no need to be out of school for more than a day,” Watt said. “There should not be prolonged absences from school because of the immunization requirement.”

Despite the increases in the rate of kindergartners now fully vaccinated “a number of schools and communities remain at risk of contagion,” the state says. For the current school year, 20 of California’s 58 counties have rates of fully-vaccinated kindergartners below 90 percent.

Here are the counties with the lowest rates of fully vaccinated kindergartners this year:

Trinity 77.0 percent

Nevada 77.1 percent

Tuolumne 77.7 percent

Mariposa 81.5 percent

Humboldt 82.0 percent

Siskiyou 83.8 percent

Many of those counties also have high rates of personal belief exemptions. But individual schools even within counties with high fully vaccinated rates may have high personal belief exemption rates.

You can look up the personal belief exemption rate at your own school below.

]]>https://ww2.kqed.org/stateofhealth/2016/01/20/why-vaccination-rates-are-up-across-california/feed/1140964Alameda County Vaccinations Surge In Wake of Enforcementhttps://ww2.kqed.org/stateofhealth/2016/01/19/alameda-county-vaccinations-surge-in-wake-of-enforcement/
https://ww2.kqed.org/stateofhealth/2016/01/19/alameda-county-vaccinations-surge-in-wake-of-enforcement/#respondTue, 19 Jan 2016 19:55:30 +0000http://ww2.kqed.org/stateofhealth/?p=140437When it comes to vaccination rates, Alameda County made the comeback of the year in California.

The county was named by state officials as the “most improved” for raising the rate of kindergartners with “up-to-date” immunizations, said Amy Pine, immunization director of the Alameda County Public Health Department.

“We made it our mission to say, ‘No shots, no records, no school,’” Amy Pine, Alameda County Public Health Department

About 97 percent of kindergartners in Alameda had up-to-date vaccinations this school year, compared to 89 percent a year ago, according to the county’s records.

“We made it our mission to say, ‘No shots, no records, no school,’ ” Pine said. “The school personnel … worked so hard. They are the heroes.”

The countywide turnaround is due in large part to improvement in vaccination rates recorded in the Oakland Unified School District. The district lifted its rates of kindergartners with up-to-date vaccinations from only 75 percent in 2014-15 to 97 percent this year.

Individual schools had major improvement, like Thornhill Elementary School in Oakland’s Montclair district, which saw its up-to-date vaccination rate skyrocket from 14 percent last year to 96 percent this year.

“We doubled down on this issue, and we’re glad to see our efforts are paying off, because what it’s really about is the health of all of our children,” said Oakland Unified School District spokesman Isaac Kos-Read.

Even though it’s an issue that gets a lot of attention in the media, the number of parents choosing not to vaccinate their children due to personal beliefs was actually not a major phenomenon in Alameda. Only 1.5 percent of kindergartners in the county had such exemptions in 2014-2015 and it fell to 1 percent this year.

All children are required to be vaccinated against a range of diseases in order to attend school — unless they have filed a “personal belief exemption” or a medical exemption with their school.

Last summer, California Gov. Jerry Brown signed a law abolishing the personal belief exemption. The law takes effect in July, and in the next school year all students must be vaccinated unless they have a medical exemption.

Alameda County’s major challenge was students with incomplete vaccination records who were allowed “conditional entry” to school. The rate of such admissions was 9.7 percent last year, and this year it has plummeted to 2 percent.

In Oakland, conditional entrants represented 25 percent of kindergartners last year, and that dropped to about 2 percent, Pine said.

The high rate of conditional entrants at some schools was in part because those exemptions were used inappropriately, she said. Some school personnel interpreted “conditional entry” to mean that students were allowed to enter school as long as their parents promised to get them the shots in the future.

But conditional entry is meant for kids who were recently vaccinated and aren’t due for the next shot in the series yet or those who have a temporary medical exemption.

Fixing the problem

Schools with low vaccination rates aren’t necessarily filled with unvaccinated children, Pine said. It’s often due to poor record keeping and administrative challenges.

School support staffers struggle to enter complete vaccination records because of turnover, lack of training and inadequate time to enter the data or follow up with parents, she said.

Also, schools have been reluctant to turn away kids just because they don’t have complete vaccinations. There was a financial disincentive to exclude children as schools get funding based on attendance, but the state has taken steps to change that, Pine said.

Schools with problematic vaccination rates in 2014-2015 received a letter saying they would be audited if their Fall 2015 rates didn’t improve, she said.

To help boost vaccination rates, Pine said, the county department ranked schools on a “community immunity” honor society based on their vaccination rates and sent the listing to school personnel. She said seeing the information displayed like that encouraged officials from schools that were ranked low to ask the county health department how they could turn that around.

The county health department worked with schools to train staff, she said. A measles outbreak tied to Disneyland, which was first reported last January, helped to boost public awareness about the importance of vaccines, encouraging parents and schools to put a priority on immunizations, Pine said.

“Schools really have to give protected and focused time to staff to do it, where they won’t be interrupted,” Pine said.

It’s challenging for front desk staff to enter data when students and parents are constantly coming up to them and signing in and out of school.

“Much of what we needed was in the records,” said Thornhill Elementary School’s secretary, Sheila Smith. “It wasn’t a matter of obtaining it. It was a matter of finding the time.”

She said entering immunization data is complicated for school staff because not all medical records look alike and the office environment is constantly distracting.

She said she asked for some dedicated time to work on the project and used personal hours as well, she said.

The principal, Steven Daubenspeck, said when he learned the school’s rate was so low last year, he began holding weekly meetings to check in with staff to increase accountability on vaccination record keeping. A lot of the information hadn’t been entered on time, he said.

“I was shocked,” he said. “I got the staff to really rally around, and focus on it. I do have immune-compromised kids here, and it’s a life-and-death issue.”

]]>https://ww2.kqed.org/stateofhealth/2016/01/19/alameda-county-vaccinations-surge-in-wake-of-enforcement/feed/0140437Must Special Ed Students Comply with Vaccine Law? It Varies by Districthttps://ww2.kqed.org/stateofhealth/2016/01/07/must-special-ed-students-comply-with-vaccine-law-it-varies-by-district/
https://ww2.kqed.org/stateofhealth/2016/01/07/must-special-ed-students-comply-with-vaccine-law-it-varies-by-district/#respondThu, 07 Jan 2016 14:45:58 +0000http://ww2.kqed.org/stateofhealth/?p=135547California now has one of the strictest vaccination laws in the country, but ambiguity in its wording has left school districts deciding on their own whether to grant special education students a de facto exemption.
‘School districts are grappling with how they want to approach this right now.’Jonathan Read, attorney

The California Department of Public Health and the California Department of Education have not yet issued guidance on how to apply the vaccination law to special education students. Under the federal Individuals with Disabilities Education Act, students who qualify for special education services, such as speech therapy or small-group instruction, must receive those services. Failure to comply leaves districts vulnerable to lawsuits from parents.

At the same time, beginning July 1, the state law will require all kindergarten, transitional kindergarten and seventh-grade students to be vaccinated against 10 communicable diseases before they are allowed to attend school, unless they have a medical condition that makes them unable to do so. Under the new law, parents can no longer refuse to vaccinate their children in public or private schools and child-care centers based on their personal beliefs.

With kindergarten enrollment beginning this month in the Sacramento City Unified School District and continuing through the spring in districts around the state, school lawyers are parsing the law on their own.

The intent of the new law is “to increase community immunity,” said Shannan Martinez, a spokeswoman for state Sen. Richard Pan, D-Sacramento, who co-authored the legislation, Senate Bill 277. Pan said he acted to address rising numbers of unvaccinated children and a corresponding increase in outbreaks of diseases once considered obliterated in the U.S., including the measles outbreak tied to Disneyland last year.

But the law appears to have unwittingly created a loophole that could be used to exempt the 10 percent of students who are enrolled in special education, a number far greater than the 2.5 percent of kindergarten students who opted out of vaccinations during the 2014-2015 school year through personal belief exemptions.

‘We are not holding anyone to vaccination requirements that would interfere with access to special education programs.’Dr. Kimberly Uyeda, L.A. Unified School District

The Los Angeles Unified School District, which serves more than 640,000 K-12 students and is the largest district in the state, has decided not to require students in special education to comply with required immunizations if that requirement would prevent them from getting services, including instruction in general education classrooms, to which they are legally entitled, said Dr. Kimberly Uyeda, director of student medical services for the district.

“We are not holding anyone to vaccination requirements that would interfere with access to special education programs,” Uyeda said. The decision was based on advice from district legal counsel, she said. The district serves about 73,000 special education students, but only “a very small number” are not fully vaccinated, she said.

“The broadest way the law can be interpreted is that special education students get access to everything, regardless of immunization status,” said Jennifer Nix, an attorney with School and College Legal Services of California. In terms of the risk of lawsuits from special education parents, “it is the safest route, but I don’t know if it’s the right route,” Nix said.

While the immunization law specifically exempts students who are home-schooled or who are enrolled in independent study with no classroom attendance, it does not use the word “exempt” to describe the status of students in special education. Instead, the law states that it does not “prohibit” special education students from access to services. Special education students wouldn’t necessarily be attending school, Martinez said.

Unlike students who are home-schooled or studying independently outside of classrooms, students who receive special education services -– they number one in 10 students in California, according to a 2015 report from the Legislative Analyst’s Office -– are in school buildings and almost always spend time in general education classrooms, physical education classes or cafeterias.

Jonathan Read, who specializes in special education law at the San Diego firm Fagen Friedman & Fulfrost, said that in the absence of guidance from the state, the immunization law is being interpreted in two ways. The first is that special education students are required by federal law to be educated in the least restrictive environment, which often means spending time in general education classrooms, and that right cannot be limited by a state law requiring them to be vaccinated to obtain access.

The second interpretation is that immunizations are a health and safety concern. While districts are obligated to make inclusive special education environments available, according to this line of reasoning, Read said, it is up to parents to decide whether they want their child to have access to those environments by having their child vaccinated.

“School districts are grappling with how they want to approach this right now,” Read said.

“There are going to be some conflicts,” said Maggie Roberts, associate managing attorney at Disability Rights California, the state’s watchdog group. “School districts will feel they have the right to keep out kids” who are not immunized, she said, while parents will press schools to fulfill their obligation to provide special education services, even if their children are not vaccinated.

Orange County has made the strongest public statement, insisting that special education students be vaccinated along with all other students on campus, except those with medical exemptions. “If you exempt all special education kids, you’re going to decrease the vaccination rate by 11 or 12 percent,” said Ronald Wenkart, general counsel for the Orange County Office of Education. “I don’t see how you can interpret the law that way.”

Wenkart has advised school districts in the county that special education students must be vaccinated.

Other districts are planning for scenarios that could include providing special education services at home for unvaccinated students or meeting with the students in separate facilities at or near school grounds.

In the Sacramento City Unified School District, Terri Fox, lead district nurse, said one plan could be to refuse to admit an unvaccinated special education student who requires only an hour or two a week of speech therapy, for instance, and instead provide services to the student offsite. The student would be home-schooled for the remainder of his or her instruction.

But unvaccinated students who require extensive academic, behavioral and therapeutic assistance all day in a special education classroom “will probably have to be admitted,” Fox said.

In the Long Beach Unified School District, Joyce Cox, program specialist for student health services, said a formal policy has not been adopted. But one idea might be to offer temporary home instruction for students in special education, she said. “That is a way you could still deliver services to the child, and still comply with the state law — but that decision has not been made,” she said.

Gail Williams, director of health services at Fresno Unified, said she will meet with parents of special education students to encourage them to vaccinate their children. If that fails, the path is not clear, she said.

“Our numbers are small,” she said. “We will handle it on a case-by-case basis.”

]]>https://ww2.kqed.org/stateofhealth/2016/01/07/must-special-ed-students-comply-with-vaccine-law-it-varies-by-district/feed/0135547More Bay Area Kids Getting Vaccinated, Preliminary Numbers Showhttps://ww2.kqed.org/stateofhealth/2015/12/28/vaccination-rates-up-california-kids-measles/
https://ww2.kqed.org/stateofhealth/2015/12/28/vaccination-rates-up-california-kids-measles/#respondTue, 29 Dec 2015 01:43:37 +0000http://ww2.kqed.org/stateofhealth/?p=131213In the face of a measles outbreak tied to Disneyland and the heated debate around a legislative move to end parents’ option not to vaccinate their children, vaccination rates are increasing across the Bay Area, a KQED analysis of preliminary state data shows.

All incoming California kindergarteners are required to be vaccinated against a range of diseases, unless the child has a medical exemption or a personal belief exemption (PBE) on file with their school. A new state law, known as SB 277, will end the PBE in July, but during the current school year, the exemption is still permitted.

‘The outbreak of measles was a real wake up call for all of us.’ Dr. Matt Willis, Marin County public health officer

Statewide, the PBE rate declined from 2.54 percent of incoming kindergartners to 2.33 percent. In addition, the percent of children receiving both doses of the measles, mumps, rubella — or “MMR” — vaccine increased from 92.55 percent to 94.59 percent statewide.

“I can only assume that this is in part a response to … the measles outbreak and the publicity that that received,” said Art Reingold, head of epidemiology at the UC Berkeley School of Public Health. “It’s unfortunate that fear or outbreaks of disease are necessary to get people to do what we’d like them to do, but I think that’s human nature.”

The California Department of Public Health collects vaccination rates from every kindergarten, public or private, with more than 10 students. It then publishes a downloadable data set and a separate summary document. This year, CDPH published the data set on its site last Thursday, Dec. 24. The summary document was not published.

KQED downloaded the data and calculated a PBE rate and an MMR rate for nine Bay Area counties and a statewide average. We contacted CDPH to request an interview about our analysis.

But late Monday, after calls from reporters, CDPH deleted the data set from its site, saying it was preliminary and incomplete, and said final data would be published by mid-January.

According to the KQED analysis, across the Bay Area, most counties saw a decline in the PBE rate when compared to last year, with the exceptions of Contra Costa and Santa Clara counties, where the rates are already below the statewide average.

Last year, Contra Costa’s PBE rate was 1.90 percent; this year it increased slightly to 1.97 percent. Santa Clara’s rate was 1.57 percent last year; this year it also increased slightly to 1.62 percent.

The PBE rates for other Bay Area counties declined, as follows:

Alameda: 1.54 percent last year to 1.20 percent this year

Marin: from 6.45 to 5.97 percent this year

Napa: from 3.18 to 3.15 percent

San Francisco: from 1.80 to 1.46 percent

San Mateo: from 1.85 to 1.62 percent

Solano: from 1.80 to 1.50 percent

Sonoma: from 5.54 to 4.69 percent

Marin County has long had the highest PBE rate in the Bay Area, but county public health officer Dr. Matt Willis called the decline in Marin’s PBE rate this year “great news” and said it was the third year in a row of increasing vaccination rates. “We haven’t seen this many children vaccinated in Marin County since 2007,” he said.

Bay Area counties saw a corresponding increase in rates of the MMR vaccine, with the exception of Napa County, where there was a small decrease. Last year, Napa’s MMR rate was 94.74 percent; this year it declined slightly to 94.51 percent.

Here are the MMR vaccination rates for the other Bay Area counties:

Alameda: from 91.40 percent last year to 97.11 percent this year

Contra Costa: from 95.52 percent to 96.34 percent

Marin: 88.03 percent to 90.97 percent

San Francisco: from 89.63 percent to 94.45 percent

San Mateo: from 94.83 percent to 96.57 percent

Santa Clara: from 95.33 percent to 96.29 percent

Solano: from 95.41 percent to 95.99 percent

Sonoma: from 91.48 percent to 93.70 percent

Alameda County had the most dramatic increase in the Bay Area in its MMR rate, more than 5.5 percentage points. Erica Pan, deputy health officer with the Alameda County Public Health Department, said that staff had noticed more than a year ago that there were many children who were not up to date on immunizations. The health department launched an outreach effort to help get children vaccinated.

The work has paid off. Over the past few years, kindergarteners up to date on vaccines had ranged from 86 to 89 percent. This year it’s more than 96 percent, Pan said.

“Between our work with the staff and various leadership, and public awareness,” she said, “that’s how we made some really dramatic improvement. We’re really excited to see the huge change in Alameda County.”

“The outbreak of measles was a real wake up call for all of us around this issue,” Willis said. “It gave us a chance to speak openly as a community about what vaccination does for us, it gave us a chance to understand vaccination as a matter of community responsibility.”

Berkeley pediatrician Olivia Lang said she’s seen a change among families in her practice. “There were a lot of families who had been waffling on vaccines, but perhaps were not strong believers in anti-vaccination ideals,” she said. “But now they’re saying, ‘Well, I guess we’re going to have to do it,'” and so they are having their children vaccinated.

SB 277 takes effect July 1. Starting with the 2016-2017 school year, all kindergarteners and 7th graders in California will need to be up to date on vaccines to enter school. Only those children who cannot be vaccinated for medical reasons will be exempt.

Sen. Richard Pan, D-Sacramento, was co-author of the new law. In an interview Monday, he said that the vocal debate around the passage of the bill helped many parents to learn more about vaccines.

“This is part of the momentum where people realize there’s a lot of misinformation about vaccines,” he said. “During the 277 debate they saw in the news that vaccines are important, that diseases have not gone away. People became educated and more aware of the importance of vaccinations.”

In an emailed statement late Monday afternoon, state epidemiologist Dr. Gil Chavez said, “The summary reports and [final] immunization status data are anticipated to be posted by Jan. 15, 2016.”

]]>https://ww2.kqed.org/stateofhealth/2015/12/28/vaccination-rates-up-california-kids-measles/feed/0131213Why You Can’t Get the Flu from the Flu Shot (Video)https://ww2.kqed.org/stateofhealth/2015/11/16/why-you-cant-get-the-flu-from-the-flu-shot-video/
https://ww2.kqed.org/stateofhealth/2015/11/16/why-you-cant-get-the-flu-from-the-flu-shot-video/#commentsMon, 16 Nov 2015 18:48:31 +0000http://ww2.kqed.org/stateofhealth/?p=109229It’s the time of year when the flu starts circulating more widely and with it — the myths about the flu shot start circulating, too.

In just over 2 minutes, The Slate does a highly entertaining job of debunking one of the most tenacious myths of all — that you can get the flu from the flu shot. You can’t.

The Centers for Disease Control recommends that everyone over 6 months get the flu shot. While effectiveness varies from year to year, this year’s version is expected to be a good match against the specific strains of influenza that are circulating this season.

]]>https://ww2.kqed.org/stateofhealth/2015/11/16/why-you-cant-get-the-flu-from-the-flu-shot-video/feed/3109229Doctors, Not Parents, Are The Biggest Obstacle To The HPV Vaccinehttps://ww2.kqed.org/stateofhealth/2015/10/23/doctors-not-parents-are-the-biggest-obstacle-to-the-hpv-vaccine/
Fri, 23 Oct 2015 19:27:22 +0000http://ww2.kqed.org/stateofhealth/?p=96929Vaccination rates against human papillomavirus have remained far lower than rates for other routine childhood and teen immunizations. But a big reason for those low rates comes from a surprising source.

It’s not hesitant parents refusing the vaccine. Rather, primary care doctors treat the HPV vaccine differently from other routinely recommended immunizations, hesitating to recommend it fully and on time and approaching their discussions with parents differently, a study finds.

“The single biggest barrier to increasing HPV vaccination is not receiving a health care provider’s recommendation,” said lead study author Melissa Gilkey, an assistant professor of population medicine at Harvard Medical School. That’s more of an issue, she says, than parents’ decisions to refuse or delay HPV vaccination.

The problem? HPV infections are most commonly — though not always — transmitted sexually.

“These findings add to a growing literature that suggests that some providers find the interpersonal environment to be challenging when it comes to talking about HPV vaccination,” said Gilkey. “Discomfort talking about sex appears to be a more salient factor” than safety concerns about the vaccine.

Nearly all cervical cancers result from HPV infections, which can also cause vaginal, vulvar, anal, penile or head and neck cancers. Although most strains of HPV infections go away on their own, a three-dose series of the vaccine protects against the strains responsible for an estimated 90 percent of HPV-related cancers.

The Centers for Disease Control and Prevention recommends it for all girls and boys ages 11 and 12 because it’s most effective prior to first engaging in sexual activity.

The vaccine has not been out long enough to establish how much cancer it will prevent, since most cancers take years to develop after an HPV infection. But multiple studies have shown reduced rates among vaccinated people of the precancerous lesions that grow into cancer.

Despite the safety and effectiveness of the vaccines, only 38 percent of teen girls and 14 percent of teen boys receive all three doses of the vaccine, the study noted, far below rates typically in the 80 and 90 percents for other vaccines.

“Although this study may surprise many, this very concern about provider hesitancy has been at the forefront of the CDC’s concern,” said William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine. He said it started with strong pushback when the vaccine debuted, as many people focused on the mode of transmission rather than the disease itself.

Concerns that the vaccine would encourage promiscuity or would cause serious side effects dominated the conversation, but dozens of studies since have proven these concerns unfounded, Schaffner explained. “So many doctors were so bruised by all that parental reaction that now they’re very tenuous,” he said.

Gilkey’s team sent out an online survey to 2,368 primary care physicians, about half pediatricians and half family doctors. Of the little over 1,000 who responded, 776 of them met the criteria and completed the survey. The results, published in Thursday in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, found that more than a quarter of the respondents (27 percent) reported that they do not strongly endorse the HPV vaccine in talking with their patients’ families.

They were also less likely to recommend on-time vaccination for boys than for girls. Nearly 2 in 5 doctors (39 percent) did not recommend on-time HPV vaccination for their male patients compared with 26 percent for female patients.

The starkest findings, however, related to how the doctors approach their discussions with parents. Only half recommend the vaccine the same day they discuss it, and 59 percent said they approach discussions by assessing the child’s risk for contracting the disease rather than consistently recommending it to all children as a routine immunization.

“We need to make the vaccine not about sex but about routine cancer prevention,” said Jennifer Edman, an assistant professor of women’s primary care at Oregon Health & Science University. Other shots recommended around the same age include the Tdap (tetanus, diphtheria, pertussis) and meningococcal vaccines, but preventing cancer can seem distant at that age, Edman added.

“It is easy to fall into the trap of negotiating with either the parent or the teen,” she said, “and the HPV vaccine can start to seem optional or of less immediate importance.”

It’s not that the physicians themselves believe the vaccine is unimportant. A full 99 percent of the respondents said they tell their patients that the HPV vaccine prevents cervical cancer and 89 percent explain it prevents genital warts, though just over half say it can prevent other cancers. It’s how they perceive the attitudes of their patients’ parents.

Nearly half of the physicians who responded (47 percent) believed that parents think of the HPV vaccine as only slightly important or not important at all for their preteen children. About a third somewhat or strongly agreed that they expected uncomfortable conversations with families about the vaccine, and a third said discussions were uncomfortable because HPV is a sexually transmitted disease. Yet these perceptions don’t match up with reality, Gilkey said.

“We were surprised that physicians viewed parents as so unsupportive of HPV vaccination because research with parents themselves tells a somewhat different story,” she said. “A lot of parents say that they just need more information. It seems clear that providers need communication strategies for recommending the HPV vaccine with greater confidence.”

The result has been very low coverage for the only vaccine besides hepatitis B that can reduce cancers.

“The needle has moved from parental hesitancy to provider hesitancy,” Schaffner said. “It’s really saddened me because for a long time, an anti-cancer vaccine was a sort of a holy grail in medical research. This is a fabulous advance in women’s and men’s health, and we’re letting young people grow into adulthood without that protection.”

Tara Haelle is a freelance health and science writer based in Peoria, Ill. She’s on Twitter: @tarahaelle

Copyright 2015 NPR. To see more, visit http://www.npr.org/.

]]>96929How U.S. Supreme Court Just Made It Tougher to Challenge California Vaccine Lawhttps://ww2.kqed.org/stateofhealth/2015/10/06/how-u-s-supreme-court-made-it-tougher-to-challenge-california-vaccine-law/
https://ww2.kqed.org/stateofhealth/2015/10/06/how-u-s-supreme-court-made-it-tougher-to-challenge-california-vaccine-law/#commentsTue, 06 Oct 2015 23:03:44 +0000http://ww2.kqed.org/stateofhealth/?p=89014The U.S. Supreme Court will not hear a challenge to a requirement in New York state that all children be vaccinated, unless they have a religious exemption, before they can attend public school. The justices on Monday let stand lower court rulings that the policy does not violate the constitution.

While the particulars of the New York vaccine mandate is somewhat different than in California, this decision still matters here. A new law passed in June requires virtually all California schoolchildren to be vaccinated against a range of diseases in order to attend school.

The high court’s move means that potential challenges to the California law are “not likely to succeed,” Prof. Dorit Reiss, a vaccine law expert at UC Hastings College of the Law in San Francisco, told KQED.

During the rancorous debate over the bill, SB277, one of the arguments I heard from those opposing it was that the Supreme Court’s major cases on childhood vaccination were decades old — or more — and that the world had changed dramatically since the last major rulings.

Yes, this is the health blog, but bear with me while we take a look at two key cases.

Reiss noted that Jacobson found “states have extensive leeway to require vaccination.”

California never had a religious exemption written into the law. Instead the state had only a “personal belief exemption,” now abolished by SB277. Only those children with a medical exemption may attend school without being vaccinated.

And that brings us to the second key case.

In 1944, the U.S. Supreme Court heard arguments in Prince v. Massachusetts. The case was not explicitly about vaccines — a Jehovah’s Witness was charged with violating child labor law by having her child sell religious material. Rather, the case is seen as one that spells out limits on parental rights. Parents do not have absolute authority over their children, and that can include decisions about vaccination. From the decision:

“The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.”

“You don’t get out of a general law because you have a religious exemption,” Reiss told me. She used taxes as an example. You may have a religious objection, but you still must pay. Because SB277 is “not aimed at a particular religion,” one cannot apply a religious exemption.

Returning to the challenge to the New York law, Reiss said that by declining an opportunity to consider it, the Supreme Court is not reaffirming these older decisions. But it is also declining an opportunity to reconsider those rulings.

It may be that the petition was denied “because there are not four justices on the Supreme Court who think Jacobson is such bad law that it should be overturned,” Reiss wrote on Skeptical Raptor.

Here in California the new vaccine law appears to raise a different constitutional question — all California children have a constitutional right to an education. Under SB277, children who are not vaccinated cannot attend school.

Is the constitutional right to an education violated by SB277?

Reiss said she believes a constitutional challenge on these grounds would be “incorrect.” She pointed to a series of famous cases in California, Serrano v. Priest, which found inequity in school financing. Schools were found to be “discriminating on wealth,” Reiss said.

But requiring schoolchildren to be vaccinated is not a violation under Serrano v. Priest, Reiss said, because choosing not to vaccinate is a behavior and not a fact of one’s existence, such as wealth or race. “It is perfectly legitimate for the state to regulate behavior, which is what SB277 does,” Reiss said.

The new law goes into effect next July 1.

Oct. 8, 2015: this post has been updated to clarify that New York state permits a religious exemption from its vaccine mandate.